I was delighted to read the article by McIntosh et al (Psychiatric Bulletin, March 2005, 29, 94-97) encouraging the use of parenteral thiamine for the early treatment of Wernicke-Korsakoff syndrome in alcoholism. Such treatment greatly improves outcome in some alcoholics (Reference Guthrie and ElliottGuthrie & Elliott, 1980; Reference MacdonaldMacdonald, 1994).

However the British National Formulary recommends one pair of high-potency ampoules twice daily for 7 days, so the guidelines given fall short of an adequate dose. Also, it is hard to detect any useful clinical response within 2 days; my own experience is that 3-4 weeks are required before improvement in memory function can be detected.